Provider Demographics
NPI:1154624591
Name:KOMALA, SARAH E (LMT)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:E
Last Name:KOMALA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 RIO RANCHO DR SE STE 6G
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1859
Mailing Address - Country:US
Mailing Address - Phone:505-891-1414
Mailing Address - Fax:505-891-1444
Practice Address - Street 1:1117 RIO RANCHO DR SE STE 6G
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1859
Practice Address - Country:US
Practice Address - Phone:505-891-1414
Practice Address - Fax:505-891-1444
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6205225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist